Active NPI
Sandra Kaye Bruggink, LPC
- Counselor
- Waukesha, WI
National Provider Identifier
1265878201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 4970-125
- Practice address
- 721 American Ave
PHMG Behavioral Medicine Center
Waukesha, WI 53188-5071 - Phone
- (262) 928-4036
- NPI assigned
- May 16, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 4970-125 | WI | Primary |
Addresses
Primary practice location
721 American Ave
PHMG Behavioral Medicine Center
Waukesha, WI 53188-5071
Mailing address
721 American Ave
PHMG Behavioral Medicine Center
Waukesha, WI 53188-5071
Phone (262) 928-4036
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4970-125 | WI | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476057600000",
"number": "1265878201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "721 AMERICAN AVE",
"address_2": "PHMG BEHAVIORAL MEDICINE CENTER",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531885071",
"telephone_number": "262-928-4036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721 AMERICAN AVE",
"address_2": "PHMG BEHAVIORAL MEDICINE CENTER",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531885071",
"telephone_number": "262-928-4036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUGGINK",
"first_name": "SANDRA",
"middle_name": "KAYE",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-16",
"last_updated": "2016-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WI",
"license": "4970-125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.